Published ahead of print on July 31, 2008, doi:10.1164/rccm.200712-1832OC Am. J. Respir. Crit. Care Med., Volume 178, Number 9, November 2008, 902-905 A more recent version of this article appeared on November 1, 2008
Submitted on December 14, 2007 Airway Bypass Improves the Mechanical Properties of Explanted Emphysematous LungsCliff K Choong1,1 Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA; Jacqueline Maritz Lung Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA; Division of Cardiothoracic Surgery, Papworth Hospital, University of Cambridge, Cambridge, United Kingdom, 2 Meakins-Christie Laboratories, Montreal Chest Institute, McGill University Health Centre Research Institute, Montreal, QC, Canada, 3 Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA, 4 Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA, 5 Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA; Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA, 6 Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA; Jacqueline Maritz Lung Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA; Division of Thoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA * To whom correspondence should be addressed. E-mail: john.a.pierce{at}sbcglobal.net.
Rationale: By creating artificial communications through bronchial walls into the parenchyma of explanted lungs (airway bypass), we expect to decrease the amount of gas trapped and to increase the rate and volume of air expelled during forced expirations. Objective: To describe the mechanism by which airway bypass improves the mechanical properties of the emphysematous lung. Methods: Lung compartments and mechanics were measured before and after airway bypass created by placement of 3 or 4 stent-suppported fenestrations in 10 emphysematous lungs removed at transplantation surgery. Results: Minimal volume after passive deflation decreased by a mean of 1.54 liters (range of 0.7 to 2.5), or 60 (37-86) percent. Explanted vital capacity increased 1.30 liters or 132 (78-318) percent. Maximal expiratory flows and volumes increased. Flow resistance decreased. Conclusion: Since these data show that airway bypass improves the mechanics of breathing in severely emphysematous lungs in vitro, there is now strong empirical support that this procedure can improve ventilatory function in patients by reducing gas trapping and flow resistance. Key words: transbronchial fenestrations, airway bypass
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